An end to sleepless nights?

by Alice Gregory, Professor of Psychology, Goldsmiths, University of London; Sleep Researcher

Raising a child with Attention Deficit Hyperactivity Disorder (ADHD) can be difficult. Some days feel long and the respite of a peaceful night, so rejuvenating for many, may not come at all. Parents often struggle to get their child to sleep, and once they do, they can’t be sure that they won’t wake up repeatedly during the night. But there’s good news for children with ADHD and their parents. In a recent study, we found that most cases of childhood ADHD resolve over time, and when that happens, sleep quality is no worse than in the rest of the population.

ADHD is a disorder that is widely considered to start in childhood and is characterised by symptoms of inattention and hyperactivity. Although many children seem to have endless energy, ADHD is different in that it gets in the way of a child’s development and functioning.

Parents of children with ADHD sometimes feel that they have a lot to worry about, including school performance and friendships. However, one particular issue that comes up time and time again is sleep. It seems that children with ADHD are more likely than others to have sleep problems such as sleeplessness.

So, what does the future hold for children with ADHD? Do they grow up to become adults who sleep poorly, with all of the possible knock-on negative effects? This was not clear from previous literature, so we investigated this question in a study of 2,232 twin children from England and Wales. We followed them from age five to 18. Of these children, 12% had ADHD during childhood.

Good news

Our findings indicate that people with ADHD as children as compared to those without, slept significantly more poorly at the age of 18. However, 78% of the children in our sample who had ADHD as a child, no longer had the disorder when they were 18. Their ADHD had resolved over time. What’s more, the sleep quality of those participants who no longer had ADHD was no worse than those who have never had it.

We think that this provides a positive message for families struggling to cope with sleep problems in children with ADHD. This disorder may resolve over time and, if it does, it is likely that the associated poor sleep will also be a thing of the past. Yes, by 18, they may be too old to spare their parents the wakeful nights, but parents want the best for their children and it will give many some welcome solace to know that things could improve in future.

Of course, there’s an element of what comes first: ADHD or sleeplessness? The story can be complex, and it is possible that the ADHD is driving the poor sleep. However, equally, poor sleep and exhaustion in children may be expressed by restlessness, and other symptoms typical of ADHD. Also, once a sleep problem, such as sleep apnoea (where breathing may stop for alarming seconds during sleep), is resolved there can be an incredibly positive knock-on effect on behaviour and concentration during the day.

We also wanted to understand the association between ADHD and poor sleep by testing another possibility: that these associations are due to influences that run in the family. So we also investigated this. We used our twin design (comparing identical and non-identical twins) to work out the extent to which genetic and environmental factors played a role in the association between ADHD and poor sleep.

Our analysis showed that the magnitude of genetic (55%) and environmental (45%) influences on the association were roughly the same. This suggests that to fully understand this association we need to consider both influences.

Despite spending a third of our lives asleep, historically, sleep has been somewhat neglected by scientists. We now know that sleep matters for many aspects of our mental health and well-being. Once we understand better the genetic and environmental influences – and use this information to predict who are vulnerable to these difficulties and how best to prevent and resolve them – we will be well placed to help families who are struggling to cope with ADHD, allowing restful nights to follow restful days.